Janet Chang, PhD, is an alumna of the Robert Wood Johnson Foundation (RWJF) New Connections Program and an assistant research scientist at the University of Connecticut. Chang received a PhD from the University of California, Davis, and a BA from Swarthmore College. She studies sociocultural influences on social support, help seeking, and psychological functioning among diverse ethnic/racial groups.
In the past year, there has been heightened national press coverage of anti-minority sentiments, and public outcry over discriminatory incidents in the United States. The publicized nature of these events stimulated intense debate. Some, especially those who believe in racial colorblindness, have argued that outraged individuals are overly sensitive and quick to assume that prejudice and discrimination are the cause. On the one hand, this perspective provides psychological comfort by downplaying the importance of race, minimizing the impression of bias, emphasizing our common humanity, and upholding egalitarian principles. On the other hand, it is upsetting and harmful because it denies the lived reality of racial/ethnic minorities. Colorblindness renders well-documented racial/ethnic disparities invisible.
Belief in colorblind ideologies perpetuates false notions that discrimination is rare. As a result, colorblindness, along with a complex host of factors, promotes ethnic/racial disparities in wide-ranging important domains, such as health and health care, criminal justice, housing, education, and employment and advancement in the workplace. Colorblindness reinforces the myth of meritocracy, which places value on individual effort and ability but overlooks structural factors that inhibit positive outcomes for vulnerable or disadvantaged populations.
Understanding Microcultures of Health: It’s Time for a ‘Deep Dive’ into Culture & Social Networks to Produce Lasting Health Change
Jason M. Fletcher, PhD, is associate professor at the La Follette School of Public Affairs, Department of Sociology, Department of Agricultural and Applied Economics, and Department of Population Health Sciences at the University of Wisconsin-Madison. He is an alumnus of the Robert Wood Johnson Foundation Health & Society Scholars program at Columbia University, where he researched the intersection of health and social networks.
While an important priority for improving health and health care in the United States is in focusing on broad notions, such as creating a Culture of Health, there is also a need to consider targeted approaches that make use of the structure of relationships that influence health. Most people consider only a small number of social contacts when discussing important matters. Even though our Facebook friends number in the hundreds or thousands, the number with whom we share close and regular geographic or social space is considerably smaller. Network science is leading the way in uncovering what our microcultures look like and how they operate; these findings should be put to further use to improve population health.
These “small worlds” of influence are known to have substantial impacts on health—as shown by numerous careful, gold-standard empirical studies. College freshman who are randomly assigned a roommate who binge drinks are more likely to binge drink, themselves. Adults whose spouses stop smoking through a clinical intervention are themselves much more likely to stop smoking. These positive and negative impacts on health spread not through broad culture but through the “microcultures” of close social ties.
Felesia Bowen, PhD, PCPNP-BC, is an assistant professor at Rutgers University School of Nursing, and a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2014-2017). Her research focuses on community-based pediatric asthma care.
When I first began working as a pediatric nurse in New Jersey 20 years ago, I was committed to getting asthma care right. I worked hard to educate my young patients and their families about the disease, how to avoid the triggers that cause attacks, and how to use their medications. I wrote asthma action plans and prescribed the correct medications to control symptoms.
It wasn’t always enough. One Monday morning, one of my young patients experienced asthma symptoms. The family followed his asthma action plan, “stepping” his medications in an effort to relieve his asthma symptoms. On Tuesday, he wasn’t feeling better, and went to the nurse practitioner (NP) in his school’s health office, who appropriately modified his treatment plan and called the asthma specialist to get a next-day appointment for him.
She remembers the young man telling her that he really needed to feel better, because he was going to his middle school graduation dance Wednesday night. On Thursday morning, he visited the NP again, still with asthma symptoms. He told her that he had missed the appointment with the asthma specialist because his mom couldn’t make it—she had health issues of her own, and three other children to care for. But he’d gone to his dance and proudly showed her his middle school class ring.
Nicole M. Brown, MD, MPH, MHS, is a general pediatrician at Montefiore Medical Center and an assistant professor of pediatrics in the Division of General Pediatrics at Albert Einstein College of Medicine at Yeshiva University in New York City. She is alumna of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars program.
Many patients have left an impression on my heart since I began my journey as a pediatrician, but one I cared for early in my career sticks with me. He was a wiry 8-year-old boy exhibiting symptoms of an anxiety and conduct disorder: He was very aggressive, had acted inappropriately with his younger sister, smeared feces around the house, and was difficult to manage. He had been severely and physically abused, and although child protective services had gotten involved, he had fallen out of the system after the case was “closed” and stopped showing up for therapy.
By the time his grandmother brought him to see me, I was the first doctor to see him in about two years. In the hour that I spent with him that day, it became clear that his treatment—or lack thereof—was inextricably bound up in his family’s various other challenges. His family lived in poverty, and faced food insecurity issues, in addition to a long, cyclical history of abuse and child protective services involvement. His grandmother was shuttling between various social service agencies, doing her best to complete forms and meet the requirements for public assistance. Yet despite her best efforts, she wasn’t really able to manage it all and, as a result, the boy’s health care was falling through the cracks.
The Robert Wood Johnson Foundation (RWJF) Human Capital Blog published nearly 400 posts this year. As we usher in 2015, we take a look back at our ten most-read 2014 posts.
Why Do Deaths from Drugs Like Oxycodone Occur in Different Neighborhoods than Deaths from Heroin? This in-depth look at the role neighborhoods play in shaping substance abuse patterns was written by RWJF Health & Society Scholars program alumna Magdalena Cerdá, PhD, MPH. She compares neighborhoods that have more fatal overdoses of opiate-based painkillers to neighborhoods in which heroin and cocaine overdoses are more likely to occur, identifying characteristics of each. Her piece generated a larger audience than any other post published on this Blog this year, with more than 22,000 visits.
How Stress Makes Us Sick was written by RWJF Health & Society Scholar Keely Muscatell, PhD. A social neuroscientist and psychoneuroimmunologist, Muscatell shares her research into the physical manifestations of stress, its relationship to inflammation, and ways people may be able to reframe their responses to stress in order to alleviate the physical reactions it can cause. Understanding how stress makes us sick, she blogs, “is of extreme importance to the health and longevity of our nation.”
Misfortune at Birth, which drew the third-largest audience among the posts published on this Blog in 2014, asks whether some premature babies are simply born in the wrong place. It reports on nurse-led research that finds seven in ten black infants with very low birth weights have the misfortune of being born in hospitals with lower nurse staffing ratios and work environments than other hospitals. The blog post was written by Eileen Lake, PhD, RN, FAAN, and Jeannette Rogowski, PhD, based on their study funded by RWJF’s Interdisciplinary Nursing Quality Research Initiative.
Mieke Beth Thomeer, PhD, is an assistant professor of sociology at the University of Alabama, Birmingham, and Debra Umberson, PhD, MSW, is a professor of sociology at the University of Texas at Austin and a 2011 recipient of a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research. The authors received the 2014 American Sociological Association’s Best Publication Award from the mental health section for an article on marital dynamics and depression that was published in Society and Mental Health.
The Centers for Disease Control and Prevention (CDC) estimates that one in 10 Americans is experiencing depression at any given time.1 Depression is a frequent topic in the media: news reports highlight the toll it takes on the diagnosed person;2,3 celebrities publicly discuss their debilitating experiences with depression;4,5 and researchers investigate biological markers of and cures for depression.6,7
Overwhelmingly, depression is depicted as an individual-level problem, a burden and difficulty for the person with it. Little attention is given to what depression means for her or his loved ones, especially for spouses. Because depression is rarely experienced in isolation, we argue that it is important to ask:
- What is the mental health impact of having a depressed spouse?
- What factors lead to the spread of depression from one spouse to the other?
- How can both spouses be supported during episodes of depression?
Brian D. Smedley, PhD, is executive director of the National Collaborative for Health Equity in Washington, D.C.
Relative to national averages, many people of color have poorer health from the cradle to the grave—beginning at birth, with higher rates of low birth weight and infant mortality; through childhood and adolescence, with higher rates of asthma and unhealthy weight; into adulthood, with higher rates of chronic disease and disability; and at the end of life, with higher rates of premature death and shortened lifespans.
Public health research shows that these health inequities are mostly attributable to factors beyond health care access and quality: As a result of residential segregation, people of color are more likely than whites to live in neighborhoods with a high concentration of health risks, and a relative paucity of health-enhancing resources. Highly-segregated communities of color are too often overrun with environmental health threats brought about by polluting industries, and vendors selling unhealthy products such as tobacco, alcohol, and high-fat, high-sugar, and/or high-sodium products. At the same time, many of these same communities lack access to affordable, nutritious food; safe spaces for exercise, recreation, and play; and high-quality schools that prepare children well for the high levels of education that are often protective of health.
For the 25th anniversary of the Robert Wood Johnson Foundation’s (RWJF) Summer Medical and Dental Education Program (SMDEP), the Human Capital Blog is publishing scholar profiles, some reprinted from the program’s website. SMDEP is a six-week academic enrichment program that has created a pathway for more than 22,000 participants, opening the doors to life-changing opportunities. Following is a profile of Steve R. Martinez, MD, MAS, FACS, a member of the 1992 class.
Washington State has one of the highest rates of breast cancer in the country. Steve R. Martinez, an award-winning surgical oncologist at the Everett Clinic, wants to uncover why.
He zeros in on Snohomish County’s large population of rural poor. Disproportionately higher rates of breast cancer there elicit questions, underscoring the challenges of eliminating health disparities.
Is it radium exposure? Something in the groundwater? Scarcity of vitamin D-rich sunlight?
“Nobody knows—and without delving into it, we’ll never find out,” says Martinez, mindful of the complex factors driving disparities.
Solutions, he adds, require probing beyond race, ethnicity, and socioeconomic status.
Ten nurses who have done outstanding work to improve health for people in their communities were named Breakthrough Leaders in Nursing last month at the Future of Nursing: Campaign for Action summit in Arizona. These emerging leaders, who are helping medically fragile children, low-income mothers, women in rural communities, and many others, hail from ten different states.
The Campaign for Action, a joint initiative of AARP and the Robert Wood Johnson Foundation, created the Breakthrough Leaders in Nursing award to celebrate nurse leadership and the importance of efforts by nurses to improve health and health care.
“It’s amazing to see the difference that these 10 people are making in their communities and the health care system,” said Susan B. Hassmiller, PhD, RN, FAAN, RWJF’s senior adviser for nursing and director of the Campaign for Action. “The lives of the people they care for are better because they fearlessly tackled—or are tackling—daunting health care challenges.”
“These outstanding leaders truly represent the future of nursing,” said Susan Reinhard, PhD, RN, FAAN, senior vice president of the AARP Public Policy Institute and chief strategist at the Center to Champion Nursing in America (CCNA), an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation.
For the 13th year in a row, and the 15th time in the 16-year history of the survey, Americans have named nurses the country’s most trusted profession. Health care providers took the top three slots in the survey this year, with medical doctors and pharmacists coming in second and third, respectively.
Gallup has asked Americans to rate the honesty and ethics of various professions each year since 1990, and nurses were first included in the survey in 1999. Every year since, with the exception of 2001 when firefighters were included following the attacks on 9/11, nurses have topped the list.
This year, four in five respondents (80%) said they would rate the honesty and ethical standards of nurses high or very high.
This Gallup poll is based on telephone interviews conducted Dec. 8-11, 2014, with a random sample of 805 adults, aged 18 and older, living in all 50 states and the District of Columbia.